Journal of Pakistan Endocrine Society

Content

2025-08-06T07:41:52+00:00

Vol. 2 | Issue No. 1 | January - June 2025

Continuous Glucose Monitoring for Diabetes Management: Experience of an Academic Tertiary Care Hospital in Pakistan

2025-07-10T17:19:01+00:00

Background: Professional continuous glucose monitoring (pCGM) is being increasingly utilized worldwide in diabetes mellitus (DM) management. This observational study describes our institutional experience using intermittent pCGM in Pakistan.

Methods: Data was collected from the records of patients who had Medtronic iPRO™-2 CGM wearable device placed from August 2016-September 2020 at the Endocrinology clinics of Aga Khan University Hospital, Pakistan.

Results: pCGM was utilized in 22 patients (mean age: 42.4 years) during the study period. Eleven (50%) had a diagnosis of DM2, 10 (45.5%) DM1 and 1 patient had (4.5%) GDM. Median time since diagnosis of DM was 15 years. Four patients were pregnant at time of pCGM testing. pCGM was worn on average for 6 days. Patients’ pCGM glucose measurements were above the target range in 40.5% of readings and below 70mg/dL in 3% of readings. Based on report review, the treating physician recommended changes in medications, dose adjustments, or lifestyle modifications at the 1-week follow-up visit. The mean baseline HbA1c value was available in 20 patients (9.01±1.92%). Amongst patients following up after 3-6 months (n=13), HbA1c significantly decreased to 9.21%±2.09% before pCGM to 7.83%±1.28% after pCGM (p=0.03).

Conclusions: The use of pCGM at our institute has been limited despite a busy diabetes practice. Cost and lack of awareness amongst providers regarding the indications and benefits from pCGM are potential factors in this underutilization of technology. A significant reduction in HbA1c values was observed in patients who had pCGM.

Frequency of Erectile Dysfunction in people with Type-2 Diabetes Mellitus at a Tertiary Care Centre

2025-06-22T20:43:42+00:00

Introduction: Erectile Dysfunction (ED) is a distressing complication of diabetes among male patients. It has a physical, psychological and social impact not only on the affected individual but also on the family and society in general. Despite being a serious concern affecting sexual health, this problem is seldom discussed by patients with physicians in developing countries. The worldwide prevalence of erectile dysfunction among male diabetic patients varies from 20% to 85%.

Objective: The aim of this study was to determine the prevalence of erectile dysfunction and associated risk factors in Type 2 diabetic men attending the tertiary care hospital in Karachi, Pakistan.

Methodology: A cross-sectional study was conducted on selected 210 adult diabetic male patients attending tertiary care hospital from Nov 2024 to Jan 2025. Simple random sample technique was used to select study participants. An international index of erectile dysfunction questionnaire, also known as the Sexual Health Inventory of Men (SHIM) containing five questions was used to assess the presence and severity of erectile dysfunction. Bivariate and multivariable binary logistic regression analysis were performed to identify factors associated with erectile dysfunction. Statistical significance was declared at p-value <0.05.

Results: In this study, we found that the overall prevalence of Erectile dysfunction among T2DM male patients was 79.04%, with 25.3% suffering from mild, 34.9% mild to moderate, 31.3 % moderate and 8.4% severe erectile dysfunction. Higher Age group
patients, longer duration of diabetes were the factors most associated with erectile dysfunction.

Conclusion: This study has revealed a high magnitude of erectile dysfunction among male diabetic patients and its association with higher age, and longer duration of diabetes. Thus, assessment and management for erectile dysfunction should be part of routine medical care for adult male diabetic patients.

Cardiac emergencies among fasting people with diabetes during Ramadan — A prospective study from Pakistan

2025-07-11T13:24:13+00:00

Aims and objectives: To observe and compare the frequency of acute cardiac emergencies among fasting people with diabetes presenting before, during, and after Ramadan.

Methodology: This prospective observational study was conducted at the Tabba Heart Institute, Karachi, Pakistan, between May and August 2017. Data were collected using a predesigned, closed-ended questionnaire for people presented who acute cardiac events in the emergency department before, during, and after the month of Ramadan. During Ramadan, the fasting status of patients was also recorded.

Results: A total of 1036 people with cardiac emergencies presented in the emergency department during the study period. Of these, 525 (50.67%) had diabetes mellitus with a mean age of 60.42±10.06 years. Heart failure was present in 37 (20.7%) people with diabetes and 25 (12%) people without diabetes before Ramadan. A total of 46 (28.6%) people with diabetes and 23 (15.6%) people without diabetes had heart failure during Ramadan. A non-significant higher frequency of acute myocardial infarction was noted among fasting people with diabetes.

Conclusion: In this study, the frequency of cardiac emergencies in people with diabetes during Ramadan was comparable before and after Ramadan. Heart failure was significantly more common among people with diabetes before and during Ramadan. Presentations with acute myocardial infarction and arrhythmias were more common outside Ramadan. No significant differences regarding acute events were found between fasting people with and without diabetes.

Healthcare Professionals’ Knowledge, Attitudes and Practices Related to Insulin use in Diabetes Care: A Cross-Sectional Study

2025-08-06T06:54:30+00:00

Background: Insulin remains a cornerstone in the management of diabetes, yet its timely initiation and optimal use remain suboptimal in many primary care settings. Understanding the knowledge, attitudes, and practices (KAP) of healthcare professionals (HCPs) is essential to address barriers to its effective use.

Objective: To assess the knowledge, attitudes, and practices of healthcare professionals regarding insulin use in diabetes management and to identify perceived barriers to its optimal utilization.

Methodology: A cross-sectional study was conducted from February to March 2025 involving 124 healthcare professionals mainly family physicians managing patients with diabetes after approval (SGHQ/783). Demographic data, professional experience, and responses to a structured KAP questionnaire were collected through Google Forms after obtaining informed consent for participation. Frequencies and percentages were calculated for categorical variables.

Results: A total of 124 healthcare professionals (HCPs) participated (around 60% male, age range 30–65 years), with a mean clinical experience of 12 years. Although 55% had no formal training on insulin, most showed adequate theoretical knowledge. Only 33% (n = 41) actively prescribed insulin, and confidence in titration was low. Major barriers to insulin use included time constraints (64.5%), fear of hypoglycemia (64%), cost/access issues (63%), patient resistance (56%), lack of training/confidence (52%), and inadequate follow-up systems (43%). Most respondents (75.8%) believed additional training would improve their confidence. Suggestions for improvement included hands-on workshops, simplified guidelines, improved follow-up support, and patient education programs.

Conclusion: The study highlights significant gaps in insulin-related knowledge and practices among healthcare professionals, despite the widespread diabetes burden. Targeted educational programs, clinical decision support tools, and strategies to improve patient acceptance may enhance insulin prescribing confidence and improve diabetes outcomes.

The Burden of Cardiometabolic Risk Factors in Young People with Type 2 Diabetes: A Cross-Sectional Analysis

2025-07-11T14:13:20+00:00

Objective: To determine the frequency and distribution of cardiometabolic risk factors among individuals with T2DM under the age of 35.

Methodology: This prospective cross-sectional study was conducted at the Baqai Institute of Diabetology and Endocrinology over eight months (July 2022 to February 2023) after obtaining approval from the Institutional Review Board. All individuals with Type 2 Diabetes Mellitus under 35 years of age, regardless of gender, were enrolled using convenience sampling after providing informed consent. Data collected included demographic details, clinical history and measurements (BMI, blood pressure, acanthosis nigricans), and relevant laboratory investigations. All information was recorded on a structured proforma and SPSS version 20.0 was used.

Results: A total of 327 T2DM patients were enrolled (58.1% male, 41.9% female), with 72.8% classified as obese (BMI ≥25 kg/m²). Hypertension was present in 23.9%, and 85.6% had poor glycemic control (HbA1c ≥7%). Dyslipidemia was highly prevalent, with over 90% showing elevated cholesterol, LDL, and triglycerides, and 88.4% having low HDL. Obesity was more common in females (p = 0.014) and associated with worse glycemic and lipid profiles. Higher HbA1c correlated with increased rates of obesity, hypertension (p = 0.027), and dyslipidemia (p < 0.001) Obese individuals had significantly higher mean HbA1c (10.20 ± 1.79, p = 0.03), triglycerides (207.60 ± 46.0 mg/dL, p = 0.001), and LDL (146.96 ± 31.36 mg/dL, p = 0.001).

Conclusion: Young adults with T2DM exhibit a high burden and clustering of cardiometabolic risk factors, underscoring the critical need for early, integrated interventions to prevent premature cardiovascular complications in this high-risk group.

A Narrative Review on Posttraumatic hypopituitarism: predictors and useful Algorithms for Investigations and Treatment (Part-2)

2025-06-23T18:54:57+00:00

Introduction: Post-traumatic hypopituitarism (PTHP) is an important but often underdiagnosed consequence of traumatic brain injury (TBI), manifesting in both acute and chronic phases. In the acute phase, adrenal insufficiency (AI) may mimic symptoms of TBI and, if untreated, can be life-threatening. During the chronic phase, growth hormone deficiency (GHD) and other hormonal abnormalities may emerge. Awareness among emergency and acute care clinicians remains low, underscoring the need for simple, evidence-based diagnostic and management algorithms.

Objectives: To review current literature on the predictors, diagnosis, and management of PTHP, and to create practical clinical algorithms to guide timely recognition and treatment.

Methodology: A narrative review of cohort studies, case-control studies, systematic reviews, and meta-analyses published from 2007 onwards was conducted using PubMed, EMBASE, and Medline.

Results: Predictors of PTHP include severe TBI, intracranial hypertension, seizures, and intracranial bleeding. Cortisol measurement at 8:00 a.m. during the first 7 days post-TBI is the preferred test for diagnosing acute hypocortisolism, although random cortisol levels may be used when clinical suspicion is high. Approximately 50–75% of patients recover normal pituitary function within one year. Hormone replacement therapy is the cornerstone of management, following standard hypopituitarism protocols. Longitudinal follow-up at 3, 6, and 12 months is essential to detect delayed hormonal deficiencies.

Conclusion: PTHP is a significant sequela of TBI that requires heightened clinical awareness and structured management. Early diagnosis and intervention can be lifesaving in acute AI and improve outcomes in chronic hormone deficiencies. Two practical algorithms were developed to assist clinicians in evaluating and managing PTHP. Further research is needed to clarify predictive factors and long-term outcomes.

Adjunctive and Emerging Therapies in Type 1 Diabetes: Closing the Gaps in Care

2025-08-06T07:00:41+00:00

A Young Female with Secondary Amenorrhea and Hirsutism: A Rare Case Report of Steroid Cell Tumor of the Ovary

2025-07-10T09:08:01+00:00

Objective: To report a case of a young female with longstanding secondary amenorrhea and hirsutism, ultimately diagnosed with an ovarian steroid cell tumor.

Methodology: A comprehensive review of the patient’s clinical presentation, biochemical profile, radiological findings, surgical intervention, and histopathology was undertaken.

Results: A 25-year-old female presented with secondary amenorrhea and progressive hirsutism for five years, accompanied by weight gain and elevated blood pressure for two years. She reported regular menstrual cycles until 2015. Clinical examination revealed a Ferriman-Gallwey score of 25, without signs of proximal myopathy or striae. Laboratory investigations showed markedly elevated serum testosterone (527 ng/dL), low luteinizing hormone (LH 0.14 mIU/mL), and low follicle-stimulating hormone (FSH 0.76 mIU/mL). Thyroid function tests and DHEA-S levels were within normal limits. Serum 17-hydroxyprogesterone (17-OHP) was elevated (10.9 ng/mL), and the overnight dexamethasone suppression test (ODST) was normal (0.70 µg/dL). Pelvic CT imaging revealed a left ovarian mass adherent to the sigmoid colon and in close proximity to the uterus and contralateral ovary. She underwent exploratory laparotomy, left salpingo-oophorectomy, and total omentectomy for tumor removal. Postoperatively, serum testosterone and 17-OHP levels normalized, and the patient resumed menstruation.

Conclusion: In women presenting with signs of virilization, a thorough evaluation is essential to differentiate between adrenal and ovarian sources of androgen excess. Although rare, ovarian steroid cell tumors should be considered in the differential diagnosis of hyperandrogenism in adult females.

When Thyroxine Isn’t Enough: Coeliac Disease as a Silent Contributor to Treatment-Resistant Hypothyroidism

2025-07-10T17:24:53+00:00

Background: Refractory hypothyroidism, characterized by persistently elevated thyroid-stimulating hormone (TSH) levels despite high-dose levothyroxine therapy, necessitates a thorough evaluation for underlying causes. While noncompliance is a common reason, it must be carefully excluded before considering alternative explanations such as malabsorption syndromes. Coeliac disease is a known but often under-recognized cause of levothyroxine malabsorption.

Case Presentation: We report the case of a 15-year-old girl with a 3-year history of primary hypothyroidism who presented with persistently elevated TSH levels (>30 mIU/L) despite daily administration of 250 mcg levothyroxine per day. She demonstrated full compliance with medication, proper intake technique, and no interfering drugs or supplements. Her low body weight (35 kg) and disproportionate levothyroxine requirement raised suspicion for malabsorption. Serologic testing revealed positive tissue transglutaminase IgA antibodies, confirming the diagnosis of coeliac disease.

Management and Outcome: The patient was commenced on a strict gluten-free diet. Within months, her TSH levels declined, levothyroxine dose requirements dropped to 50 mcg/day, and her weight increased to 42 kg. Her most recent TSH is 1.3 mIU/L reflecting euthyroidism.

Conclusion: This case highlights the importance of considering coeliac disease as a cause of refractory hypothyroidism when noncompliance and administration errors have been clearly excluded. Identifying and treating the underlying malabsorption with a gluten-free diet can significantly reduce hormone requirements and restore euthyroidism.